Jordan Hill Full Programme

Registration Form

Child's Full Name*
First Surname
Date of Birth*
Gender*
- Male
- Female
Place of Birth*
State*
Nationality*
First Language*
Religion*
Home Language*
Programme Preference*
Programme Session*
SCHOOL ATTENDING
Name*
Class*
City/Country*
FATHER’S DETAILS
Name*
State/Nationality*
Occupation*
Email*
Office Address*
Telephone*
Tel. for Whatsapp Group (if interested)
MOTHER’S DETAILS
Name*
State/Nationality*
Occupation*
Email*
Office Address*
Telephone*
Tel. for Whatsapp Group (if interested)
GUARDIAN’S DETAILS (If Applicable)
Name
Telephone
Relationship to Pupil
Email
Address
ADDITIONAL DETAILS
Any other information relevant to this application?
Child lives with?*
- Both Parents
- Father
- Mother
- Guardian
Home Address*
Parent’s instruction for medical care in case of emergency
Child’s Special Interest
Upload proof of payment*
Child's Passport Photo*
Allowed Ext: jpg, gif, png Max Size: 5mb
Programme Session*
GDPR Accepted On*
- I agree with storage, handling and use of my data and media by this Jordan Hill Creative Writing & Reading Workshop.
Name
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